Addendum To 'The Mythology Of Science-Based Medicine'

Note: A recent blog post co-authored by Larry Dossey, Deepak Chopra and Rustum Roy, entitled "The Mythology of Science-Based Medicine" caused quite a stir in the HuffPost community. The authors would like to respond to specific criticisms raised against them, as well as clarify the issue further.

The following is a response to HuffPost member Spw's comment (reproduced below):

You make some pretty amazing claims -- I would like to see some examples of the treatments that are unknown in their effectiveness. 43 percent of 2500 is 1125 treatments that may not work! The British Medical Journal is on the web -- I looked through the papers published in December and didn't find the one you cite. A search for "common medical treatments" also did not turn up your article. Let the rest of us read the original article for ourselves.

I didn't have time to check all of your claims, but I did find a Commentary written by Barbara Starfield in the Journal of the American Medical Association in 2000. You cite her as claiming that:

"between 230,000 and 284,000 deaths occur each year in the US due to ... physician error"

This is NOT what her commentary says. The correct quote is "an estimated 44,000 to 98,000 among them die each year as a result of medical errors."

That is still a lot of people, but only a fraction of what you claim! Where did you get your numbers? You can even read the original report, "To Err Is Human" online for free at the National Academies Press www.nap.edu

To paraphrase Carl Sagan, extraordinary claims require extraordinary evidence. You make extraordinary claims, but give made-up numbers from sources you either do not cite or cite incorrectly. Given this I don't know if I should believe anything else in this article.

In response, Larry, Deepak and Rustum offer the following:

SPW , you are correct: our claims are indeed "pretty amazing." We'll answer your concerns in the order you stated them.

For the breakdown of categories of conventional therapies cited by the Clinical Evidence initiative of the British Medical Journal (unknown effectiveness, beneficial, ineffective, harmful, or trade-off between benefit and harm), see here. For a review of a host of treatments for various conditions and their effectiveness, see the British Medical Journal'sClinical Evidence site.

We cited statistics that estimate the deaths that occur each year in U. S. hospitals due to iatrogenic effects. We used the term "physician error" in an expansive sense. We specifically take iatrogenesis to include physician error but also negligence, adverse effects and interactions of drugs, and hospital-acquired infections. Starfield's study, we observed, estimates 225,000 annual deaths. (Starfield B (2000). "Is US health really the best in the world?" Journal of the American Medical Association. 284 (4): 483-5) The Institute of Medicine's estimates for deaths due solely to medical errors are higher than Starfields (Kohn L, ed., Corrigan J, ed., Donaldson M, ed. To Err Is Human: Building a Safer Health System. Washington, DC: National Acadey Press, 1999). We inadvertently transposed the Starfield and IOM figures; thanks for bringing this to our attention.

Yet our conclusion stands: using even the low figure of 225,000 annual in-hospital deaths, hospital care ranks third, behind heart disease and cancer, as a leading cause of death. It is true that some authorities suggest that these statistics are inflated, and have therefore claimed that hospital deaths are "only" the fifth or sixth leading cause of death in the U.S. Even if they are correct, this should still be regarded as a national scandal.

The situation is actually much grimmer than we described. The statistics we cited refer only to deaths in hospitals. They do not include the suffering and disability patients experience from iatrogenic causes that do not result in death. Neither do they include mishaps and side effects that occur in outpatient settings, such as doctors' offices. One analysis found that between four percent and 18 percent of consecutive outpatients experience negative effects in outpatient settings, resulting in 116 million extra physician visits, 77 million extra prescriptions, 17 million emergency room visits, 8 million hospitalizations, three million long-term admissions, and 199,000 additional deaths. (Weingart SN et al. "Epidemiology and medical error." BritishMedical Journal. 2000; 320: 774-777)

By the way, you wrongly attributed your comment about extraordinary claims requiring extraordinary evidence to astronomer Carl Sagan. Philosopher Marcello Truzzi originally stated this maxim in the Fall/Winter 1976 edition of The Zeitetic. Sagan repeated it later. In any case, we believe our extraordinary claims are indeed supported by extraordinary evidence, and we thank you for your comments.